| NPI | 1881864379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN E ROACH Executive Director 217-523-9201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-04-20 |